Preoperative Bacterobilia Is an Independent Risk Factor of SSIs after Partial PD

2020 ◽  
Vol 37 (5) ◽  
pp. 428-435
Author(s):  
Ioannis Mintziras ◽  
Elisabeth Maurer ◽  
Veit Kanngiesser ◽  
Michael Lohoff ◽  
Detlef K. Bartsch
Keyword(s):  
Independent Predictor ◽  
Multivariable Analysis ◽  
Postoperative Outcome ◽  
Surgical Site Infections ◽  
Complete Information ◽  
Infectious Complications ◽  
Preoperative Biliary Drainage ◽  
Pancreatic Fistulas ◽  
Partial Pancreaticoduodenectomy ◽  
The Impact

Introduction: The impact of bacterobilia on postoperative surgical and infectious complications after partial pancreaticoduodenectomy (PD) is still a matter of debate. Methods: All patients undergoing PD with and without a preoperative biliary drainage (PBD) with complete information regarding microbial bile colonization were included. Logistic regression was applied to assess the influence of bacterobilia on postoperative outcome. Results: One hundred seventy patients were retrospectively analysed. Clinically relevant postoperative complications (Clavien-Dindo ≥ III) occurred in 40 (23.5%) patients, clinically relevant postoperative pancreatic fistulas in 29 (17.1%) patients, and surgical site infections (SSIs) in 16 (9.4%) patients. Thirty-seven of 39 (94.9%) patients with PBD and 33 of 131 (25.2%) patients without PBD had positive bile cultures (p < 0.001). A polymicrobial bile colonization was reported in 9 of 33 (27.3%) patients without PBD and 27 of 37 (73%) patients with PBD (p < 0.001). Resistance to ampicillin-sulbactam was shown in 26 of 37 (70.3%) patients with PBD and 12 of 33 (36.4%) patients without PBD (p = 0.001). PBD (OR 0.015, 95% CI 0.003–0.07, p < 0.001) and male sex (OR 3.286, 95% CI 1.441–7.492, p = 0.005) were independent predictors of bacterobilia in the multivariable analysis. Bacterobilia was the only independent predictor of SSIs in the multivariable analysis (OR 0.143, 95% CI 0.038–0.535, p = 0.004). Conclusions: Patients with a PBD show significantly higher rates of bacterobilia, polymicrobial bile colonization, and resistance to ampicillin-sulbactam. Bacterobilia is an independent predictor of SSI after PD.

scholarly journals 910. A Comprehensive, One Year, Hospital-Wide Snapshot of All Serious Infectious Complications in People Who Inject Drugs

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S489-S490
Author(s):  
John T Henderson ◽  
Evelyn Villacorta Cari ◽  
Nicole Leedy ◽  
Alice Thornton ◽  
Donna R Burgess ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Vertebral Osteomyelitis ◽  
The United States ◽  
Infectious Complications ◽  
Data Set ◽  
Cumulative Impact ◽  
Mortality And Morbidity ◽  
Icu Admission ◽  
Risk Of Death ◽  
The Impact

Abstract Background There has been a dramatic rise in IV drug use (IVDU) and its associated mortality and morbidity, however, the scope of this effect has not been described. Kentucky is at the epicenter of this epidemic and is an ideal place to better understand the health complications of IVDU in order to improve outcomes. Methods All adult in-patient admissions to University of Kentucky hospitals in 2018 with an Infectious Diseases (ID) consult and an ICD 9/10 code associated with IVDU underwent thorough retrospective chart review. Demographic, descriptive, and outcome data were collected and analyzed by standard statistical analysis. Results 390 patients (467 visits) met study criteria. The top illicit substances used were methamphetamine (37.2%), heroin (38.2%), and cocaine (10.3%). While only 4.1% of tested patients were HIV+, 74.2% were HCV antibody positive. Endocarditis (41.1%), vertebral osteomyelitis (20.8%), bacteremia without endocarditis (14.1%), abscess (12.4%), and septic arthritis (10.4%) were the most common infectious complications. The in-patient death rate was 3.0%, and 32.2% of patients were readmitted within the study period. The average length of stay was 26 days. In multivariable analysis, infectious endocarditis was associated with a statistically significant increase in risk of death, ICU admission, and hospital readmission. Although not statistically significant, trends toward mortality and ICU admission were identified for patients with prior endocarditis and methadone was correlated with decreased risk of readmission and ICU stay. FIGURE 1: Reported Substances Used FIGURE 2: Comorbidities FIGURE 3: Types of Severe Infectious Complications Conclusion We report on a novel, comprehensive perspective on the serious infectious complications of IVDU in an attempt to measure its cumulative impact in an unbiased way. This preliminary analysis of a much larger dataset (2008-2019) reveals some sobering statistics about the impact of IVDU in the United States. While it confirms the well accepted mortality and morbidity associated with infective endocarditis and bacteremia, there is a significant unrecognized impact of other infectious etiologies. Additional analysis of this data set will be aimed at identifying key predictive factors in poor outcomes in hopes of mitigating them. Disclosures All Authors: No reported disclosures

4070Clinical impact of mitral regurgitation before or following transcatheter aortic valve replacement in patients with aortic stenosis: a nationwide multivariable analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Fauchier ◽  
A Bernard ◽  
A Bisson ◽  
T Lacour ◽  
J Herbert ◽  
...  
Keyword(s):  
Transcatheter Aortic Valve Replacement ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Total Mortality ◽  
Transcatheter Aortic Valve ◽  
Mortality Hazard ◽  
History Of ◽  
The Impact ◽  
Mortality Hazard Ratio

Abstract Patients undergoing transcatheter aortic valve replacement (TAVR) may have concomitant mitral regurgitation (MR). The impact of MR at baseline or after TAVR on subsequent prognosis remains to be more precisely determined. We analysed the impact of MR before or after TAVR on prognosis in the systematic analysis of patients treated with TAVR at a nationwide level. Methods Based on the French administrative hospital-discharge database, the study collected information for all consecutive patients with aortic stenosis treated with transfemoral TAVR in France between 2008 and 2018. Cox regression was used for the analysis of predictors of events during follow-up. Results A total of 47,872 patients with transfemoral TAVR were included in the analysis (mean age 83±7 years). Moderate/severe MR was present at baseline (MRb) in 9.5% of the patients. Few patients (1.6%) revealed moderate/severe MR post-TAVR (MRpt). Mean follow-up was 1.31±1.61 years. MRb was associated with an increased cardiovascular mortality (Hazard ratio 1.29, 95% CI 1.20–1.39) and total mortality (Hazard ratio 1.15, 95% CI 1.10–1.21). However, MRb was not an independent predictor in multivariable analysis, neither for cardiovascular mortality (adjusted HR 1.06, 95% CI 0.98–1.14) nor for total mortality (adjusted HR 1.01, 95% CI 0.96–1.07). MRpt was not a predictor of cardiovascular or total mortality. Older age, male sex, history of pulmonary edema/cardiogenic shock, atrial fibrillation, myocardial infarction, diabetes, renal failure, liver disease, pulmonary disease, previous cancer and anemia at baseline independently predicted mortality during follow-up. All of them (but history of cancer) were also independent predictor of cardiovascular death. Conclusion Baseline MR was associated with increased cardiovascular and totality mortality following TAVR but was not an independent predictor of any of them. By contrast, several other predictors of cardiovascular and total mortality were identified. This suggests that MR should not be directly considered to establish the strategy for TAVR decision or for avoiding TAVR-related futility.

The Impact of a Colorectal Care Bundle for Surgical Site Infections at an Academic Disproportionate Share Hospital With a Level I Trauma Center

2020 ◽  
Vol 86 (7) ◽  
pp. 848-855
Author(s):  
Luv N. Hajirawala ◽  
Timothy B. Legare ◽  
Simon Peter T. Tiu ◽  
Amy M. DeKerlegand ◽  
Jeffrey S. Barton ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Surgical Site Infections ◽  
Care Bundle ◽  
Limited Data ◽  
Elective Colorectal Surgery ◽  
Care Bundles ◽  
Risk Patients ◽  
Multivariable Analyses ◽  
Level I ◽  
The Impact

Objectives Colorectal care bundles for surgical site infections (CRCB-SSIs) have been shown to reduce SSIs following elective colorectal surgery (CRS). There are limited data evaluating the effect of CRCB-SSI at Academic Disproportionate Share Hospitals (ADSH) with significant rates of urgent and emergent cases. Methods A CRCB-SSI was implemented in April 2016. We reviewed medical records of all patients undergoing colon resections between August 2015 and December 2017. Patients were divided into preimplementation and postimplementation groups. The primary endpoint was the SSI rate, and the secondary endpoint included types of SSI (superficial, deep, organ space). Univariable and multivariable analyses were performed. A subset analysis was performed in elective cases. Results We analyzed a total of 417 patients. Of these, 116 (28%) and 301 (72%) patients were in the preimplementation and postimplementation groups, respectively. The rate of SSI decreased from 30.1% to 15.9% in the postimplementation group ( P = .0012); however, it was not statistically significant after adjusting for baseline differences (relative risk [RR] 0.65; 95% CI 0.41-1.02). The elective subset included 219 patients. The rate of SSI in this cohort decreased from 25% to 10.5% in the postimplementation group ( P = .0012) and remained significant following multivariable analysis (RR 0.41, 95% CI 0.19- 0.88). There were no differences in the subtypes of SSI. Discussion While the CRCB-SSI was effective in decreasing the postoperative SSI rate for elective cases, its effect on the overall patient population was limited. CRCB-SSIs are not enough to bring SSI rates to accepted rates in high-risk patients such as those seen at ADSH.

scholarly journals Preoperative Thrombocytopenia May Predict Poor Surgical Outcome after Extended Hepatectomy

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Mohammad Golriz ◽  
Omid Ghamarnejad ◽  
Elias Khajeh ◽  
Mohammadsadegh Sabagh ◽  
Markus Mieth ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Platelet Count ◽  
Independent Predictor ◽  
Postoperative Outcome ◽  
High Morbidity ◽  
Extended Hepatectomy ◽  
Platelet Counts ◽  
Extended Liver Resection ◽  
Predictive Role ◽  
The Impact

Background. It is a novel idea that platelet counts may be associated with postoperative outcome following liver surgery. This may help in planning an extended hepatectomy (EH), which is a surgical procedure with high morbidity and mortality. Aim. The aim of this study was to evaluate the predictive potential of platelet counts on the outcome of EH in patients without portal hypertension, splenomegaly, or cirrhosis. Methods. A series of 213 consecutive patients underwent EH (resection of ≥ five liver segments) between 2001 and 2016. The association of preoperative platelet counts with posthepatectomy liver failure (PHLF), morbidity (based on Clavien-Dindo classification), and 30-day mortality was evaluated using multivariate analysis. Results. PHLF was detected in 26.3% of patients, major complications in 26.8%, and 30-day mortality in 11.3% of patients. Multivariate analysis revealed that the preoperative platelet count is an independent predictor of PHLF (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.3–15.0, p=0.020) and 30-day mortality (OR 4.4, 95% CI 1.1–18.8, p=0.043). Conclusions. Preoperative platelet count is associated with PHLF and mortality following extended liver resection. This association was independent of other related parameters. Prospective studies are needed to evaluate the predictive role and to determine the impact of preoperative correction of platelet count on postoperative outcomes after EH.

scholarly journals Does Fungal Biliary Contamination after Preoperative Biliary Drainage Increase Postoperative Complications after Pancreaticoduodenectomy?

Cancers ◽  
2020 ◽  
Vol 12 (10) ◽  
pp. 2814
Author(s):  
Pauline Tortajada ◽  
Alain Sauvanet ◽  
Stephanie Truant ◽  
Nicolas Regenet ◽  
Régis Souche ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Bacterial Contamination ◽  
Fungal Infections ◽  
Infectious Complications ◽  
Preoperative Biliary Drainage ◽  
Published Data ◽  
Complication Rates ◽  
Fungal Contamination ◽  
Global Rate ◽  
The Impact

(1) Background: preoperative biliary drainage before pancreaticoduodenectomy (PD) is associated with bacterial biliary contamination (>85%) and a significant increase in global and infectious complications. In view of the lack of published data, the aim of our study was to investigate the impact of fungal biliary contamination after biliary drainage on the complication rate after PD. (2) Methods: a multicentric retrospective study that included 224 patients who underwent PD after biliary drainage with intraoperative biliary culture. (3) Results: the global rate of positive intraoperative biliary sample was 92%. Respectively, the global rate of biliary bacterial contamination and the rate of fungal contamination were 75% and 25%, making it possible to identify two subgroups: bacterial contamination only (B+, n = 154), and bacterial and fungal contamination (BF+, n = 52). An extended duration of preoperative drainage (62 vs. 49 days; p = 0.08) increased the risk of fungal contamination. The overall and infectious complication rates were not different between the two groups. In the event of postoperative infectious or surgical complications, the infectious samples taken did not reveal more fungal infections in the BF+ group. (4) Conclusions: fungal biliary contamination, although frequent, does not seem to increase the rate of global and infectious complications after PD, preceded by preoperative biliary drainage.

scholarly journals Is mild hypernatremia an independent predictor of poor clinical outcome in neurocritically ill patients?

2020 ◽  
Author(s):  
Yun Im Lee ◽  
Joonghyun Ahn ◽  
Jeong-Am Ryu
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Poor Clinical Outcome ◽  
Neurosurgical Patients ◽  
The Impact

Abstract We investigated the impact of hypernatremia on mortality of neurocritically ill patients. Among neurosurgical patients admitted to the intensive care unit (ICU) from January 2013 to December 2019, the patients who were hospitalized in the ICU for more than 5 days included. Hypernatremia was defined as the highest serum sodium level exceeding 150 mEq/L observed. Among 1,146 patients, 353 patients (30.8%) showed hypernatremia. Based on propensity score matching, 290 pairs were analyzed. Hypernatremia group had higher rates of in-hospital mortality compared with non-hypernatremia group in overall and matched population (p < 0.001 and p = 0.001, respectively). In multivariable analysis of propensity score-matched population, moderate and severe hypernatremia were significantly associated with in-hospital mortality (adjusted odds ratio [OR]: 4.58, 95% confidence interval [CI]: 2.15 – 9.75 and adjusted OR: 6.93, 95% CI: 3.46 – 13.90, respectively) compared with the absence of hypernatremia. However, in-hospital mortality was not significantly different between non-hypernatremia and mild hypernatremia groups (p = 0.720). Interestingly, mild hypernatremia group of matched population showed the best survival rate. Eventually, moderate and severe hypernatremia were associated with poor clinical outcomes in neurocritically ill patients. However, prognosis of the patients with mild hypernatremia was similar with those without hypernatremia.

scholarly journals Impact of bodyweight-adjusted antimicrobial prophylaxis on surgical-site infection rates

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
L Salm ◽  
W R Marti ◽  
D J Stekhoven ◽  
C Kindler ◽  
M Von Strauss ◽  
...  
Keyword(s):  
Single Dose ◽  
Prospective Study ◽  
Antimicrobial Prophylaxis ◽  
Multivariable Analysis ◽  
Surgical Site Infections ◽  
Double Dose ◽  
Infection Rates ◽  
The Impact ◽  
Wound Class ◽  
To Receive

Abstract Background Antimicrobial prophylaxis (AMP) adjustment according to bodyweight to prevent surgical-site infections (SSI) is controversial. The impact of weight-adjusted AMP dosing on SSI rates was investigated here. Methods Results from a first study of patients undergoing visceral, vascular or trauma operations, and receiving standard AMP, enabled retrospective evaluation of the impact of bodyweight and BMI on SSI rates, and identification of patients eligible for weight-adjusted AMP. In a subsequent observational prospective study, patients weighing at least 80 kg were assigned to receive double-dose AMP. Risk factors for SSI, including ASA classification, duration and type of surgery, wound class, diabetes, weight in kilograms, BMI, age, and AMP dose, were evaluated in multivariable analysis. Results In the first study (3508 patients), bodyweight and BMI significantly correlated with higher rates of all SSI subclasses (both P &lt; 0.001). An 80-kg cut-off identified patients receiving single-dose AMP who were at higher risk of SSI. In the prospective study (2161 patients), 546 patients weighing 80 kg or more who received only single-dose AMP had higher rates of all SSI types than a group of 1615 who received double-dose AMP (odds ratio (OR) 4.40, 95 per cent c.i. 3.18 to 6.23; P &lt; 0.001). In multivariable analysis including 5021 patients from both cohorts, bodyweight (OR 1.01, 1.00 to 1.02; P = 0.008), BMI (OR 1.01, 1.00 to 1.02; P = 0.007) and double-dose AMP (OR 0.33, 0.23 to 0.46; P &lt; 0.001) among other variables were independently associated with SSI rates. Conclusion Double-dose AMP decreases SSI rates in patients weighing 80 kg or more.

The impact of preoperative ASA score and serum albumin on early complication and survival rate of patients undergoing radical cystectomy for bladder cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4576-4576
Author(s):  
Hooman Djaladat ◽  
Adrian Stuart Fairey ◽  
Jie Cai ◽  
Gus Miranda ◽  
Eila C. Skinner ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Serum Albumin ◽  
Radical Cystectomy ◽  
Complication Rate ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Early Complication ◽  
Preoperative Serum ◽  
The Impact ◽  
Low Serum

4576 Background: American Society of Anesthesiologist Score (ASA-S) is used to evaluate patient physical status before surgery. Serum albumin (Alb) is also a marker of nutritional status. We evaluated the impact of preoperative ASA-S and Alb on early complication rate and survival of patients who underwent radical cystectomy for bladder cancer. Methods: 1964 patients with primary bladder cancer underwent radical cystectomy between 1971 and 2008 at USC. Preoperative serum Alb and ASA-S were available in 1471 and 1140 patients respectively. Post cystectomy early complication was defined as any surgery related/unrelated event leading to lengthening hospital stay or re-admission within 90 days of surgery. Recurrence free survival (RFS) and overall survival (OS) for these cohorts were reviewed using a Kaplan-Meier and Cox proportional hazards models. Results: The demographic data of patients based on their serum Alb and ASA-S is presented in the Table. The median follow up was 12.4 years (0 - 36.6 yrs). Low serum Alb (<3.4 g/dL) and high ASA-S (3 or 4) were associated with higher early complication rate (43% vs. 33%, p= 0.03 and 40% vs. 28%, p= 0.0001 respectively). In multivariable analysis, low serum Alb level was an independent predictor of RFS (HR 1.35, 95% CI 1.00-1.81) and OS (HR 1.62, 95% CI 1.29-2.04). High ASA-S was an independent predictor of OS (HR 1.45, 95% CI 1.13-1.85), but not RFS. Conclusions: Preoperative low serum Alb and high ASA-S are independently predictive of post cystectomy decreased OS. Low serum Alb is also a risk factor for recurrence after cystectomy. These parameters potentially could be used in nomograms to predict post-cystectomy prognosis. [Table: see text]

scholarly journals Impact of Clinical Response to Neoadjuvant Chemotherapy in the Era of Robot Assisted Radical Cystectomy: Results of a Single-Center Experience

2020 ◽  
Vol 9 (9) ◽  
pp. 2736
Author(s):  
Umberto Anceschi ◽  
Aldo Brassetti ◽  
Gabriele Tuderti ◽  
Maria Consiglia Ferriero ◽  
Manuela Costantini ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Radical Cystectomy ◽  
Residual Disease ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Complete Response ◽  
Rank Test ◽  
Single Center Experience ◽  
The Impact ◽  
Response To Neoadjuvant Chemotherapy

Background: Response to neoadjuvant chemotherapy (NACT) has been proven to be an established prognostic factor after open radical cystectomy (ORC). We evaluated the impact of NACT on survival outcomes of a single-institution robotic radical cystectomy (RARC) series. Methods: From January 2012 to June 2020, 79 patients were identified. Baseline, demographic, perioperative, and pathologic data were described. Kaplan–Meier with the log-rank test was used to compare overall survival (OS) differences between complete, partial, and no-NACT responders, respectively. Univariable and multivariable regression analyses were performed to identify predictors of OS. Results: Complete, partial, and absent response to NACT were recorded in 43 (54.4%), 21 (19%), and 15 (26.6%) patients, respectively. A complete response to NACT displayed a trend toward significant higher OS (p = 0.03). In univariable analysis, significant predictors of lower OS were hypertension (HR 3.37; CI 95% 1.31–8.62; p = 0.01); advanced nodal involvement (HR 2.41; CI 95% 0.53–10.9; p < 0.001); and incomplete response to NACT (HR 0.41; CI 95% 0.18–0.95; p = 0.039). In multivariable analysis, the only independent predictor of worse OS was advanced pathologic N stages (HR 10.1; CI: 95% CI 2.3–44.3; p = 0.002). Conclusions: Complete response to NACT is associated with increased OS probability, but significant nodal residual disease remains the only independent predictor of OS after RARC.

105 The Impact of Flap Timing and Mechanism of Injury on Flap Complications in Acute Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S69-S70
Author(s):  
Clifford C Sheckter ◽  
David Perrault ◽  
Danielle H Rochlin ◽  
Christopher H Pham ◽  
Yvonne L Karanas
Keyword(s):  
Independent Predictor ◽  
Multivariable Analysis ◽  
Inhalation Injury ◽  
Electrical Injury ◽  
Burn Patients ◽  
Burn Care ◽  
Flap Coverage ◽  
Comorbidity Index ◽  
The Mean ◽  
The Impact

Abstract Introduction Burn wounds are often amenable to excision and grafting, but pedicled and free flaps are sometimes necessary to achieve closure of complex wounds. Flap coverage of exposed bone, tendons and cartilage has classicaly been delayed in acute burn patients due to concern of progressive tissue necrosis, microvascular thrombosis and percieved high failure rates. More recently, a number of reports have demonstrated that the use of flaps is safe earlier in acute burn care. We aim to elucidate the role of flaps in primary burn woud coverage leveraging national US data. Methods Acute burn patients with known % total body surface area were extracted from the Nationwide/National Inpatient Sample from 2002–2014 based on International Classification of Disease (ICD) Codes 9th edition. Flap procedures were identified based on ICD-9 procedure codes. Flap and non-flapped patients were compared using multivariable analysis. Variables included age, gender, race, Elixhauser comorbidity index, %TBSA, burn mechanism, inhalation injury, and location of burn. Flap complication was defined by ICD-9 procedure code 8675, return to OR for revision of flap. Multivariable analysis evaluated predictors of flap compromise based on stepwise logistic regression with backwards elimination. Results The weighted sample included 306,924 encounters of which 526 received a flap (0.17%). The mean age of encounters receiving a flap was 45.0 (SD 21.2) years versus 35.5 (SD 24.2) years in the non flap group (p=0.023). 7.8% of patients who received a flap suffered electric injury compared to 2.7% of non-free flap encounters (OR 3.76, 95% CI 1.95–7.24, p&lt; 0.001). Patients who underwent flap wound coverage were more likely to have a lower extremity burn; 55.3% of encounters versus 43.1% in non- flap patients (OR 2.26, 95% CI 1.05–2.15, p=0.024). There were no significant differences in gender, race, Elixhauser comorbidity index, %TBSA, or inhalation injury. The mean hospital day of the flap procedure was 10.1 (SD 10.7) days. Flap complications occurred in 6.4% of flap encounters. The only independent predictor of flap complication was electrical injury (OR 40.49, 95% OR 2.98–550.64, p=0.005). The time to flap coverage and location were not associated with complications. Conclusions Electrical injury was an independent predictor of flap complications compared to other mechanisms. Flap timing was not associated with return to surgery for complications. This suggests that the use of flaps is safe in acute burn care to achieve burn wound closure with an understanding that electrical injuries may deserve particular consideration to avoid failure. Applicability of Research to Practice Inform surgeon decision making when deciding candidacy for flap surgery in acute burn patients.

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